POS1508-HPR USE OF PHYSICAL THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS OR AXIAL SPONDYLOARTHRITIS: THE PATIENT´S PERSPECTIVE
Authors: M. Van Wissen, B. Straathof, T. P. M. Vliet Vlieland, M. Teuwen, C. Van den Ende, W. Peter, M. G. J. Gademan, S. Van Weely
Journal: Annals of the Rheumatic Diseases (2022)

Background In national and international management guidelines physical therapy (PT) is a recommended treatment for people with inflammatory arthritis (IA). Based on multiple systematic reviews, concluding that supervised exercise therapy and exercise promotion is an effective and safe PT treatment option in patients with IA, recommendations in particular endorse active PT treatment. In order to monitor and enhance the quality of PT in clinical practice, knowledge about its delivery, including its active content, is needed. Objectives To assess the use, frequency, duration and content of PT in patients with IA. Methods In this cross-sectional, national study a link to an electronic questionnaire addressing people with rheumatic and musculoskeletal diseases was published between December 2020-July 2021 by the Dutch Arthritis Foundation via their website, newsletter and various social media. It comprised questions on demographic and health characteristics, the EuroQol 5-Dimensions 5-Levels (EQ5D5L) and 29 questions on the usage of PT currently and/or in the past 12 months and, if applicable, the duration, frequency and content of the PT treatment. The content of PT was categorized into exercises (active aerobic, muscle strengthening, range of motion and/or functional exercises), manual treatment, physical modalities and counseling/education. Only data from patients self-identifying as diagnosed with rheumatoid arthritis (RA) and/or axial spondyloarthritis (axSpA) were used for the current study. Results A total of 267 people with RA (mean (SD) age 54 (12) years, 96% female) and 104 people with axSpA (age 47 (13) years, 88% female) (10 patients with both diagnoses) completed the questionnaire. More than 90% were treated by a rheumatologist; the mean (SD) EQ5D5L of people with RA was 0.62 (0.2) and of axSpA 0.59 (0.2). 172 RA respondents (64%) reported the use of PT related to their RA (162 individual PT, 1 group PT, 9 both individual and group PT). In axSpA, the rate was 87 (84%; 77 individual PT, 2 group PT, 8 both individual and group PT). Of those reporting individual PT treatment, the duration was long-term (&gt; 3 months) in 134 (89%) and 70 (89%) of the respondents with RA and axSpA respectively, with a duration of more than 2 years in 67 (44%) and 38 (48%). In all users of individual PT, the mean frequency was once per week or less in 116 (77%) of the RA and 63 (80%) of the axSpA patients. Proportions were based on number of respondents to questions on individual PT. Concerning the content of individual PT, and taking into account both short-term and long-term use, for active exercises, the proportion of patients reporting aerobic, muscle strengthening, range of motion or functional exercises ranged from 40-66% in RA and 24-73% in axSpA patients. Regarding manual treatment, the proportions were 61% and 58%, in RA and 73% and 72% in axSpA for massage and passive mobilizations, respectively. With respect to physical modalities (passive), the modality most frequently mentioned were kinesiotaping and dry needling (40 and 25% and 43 and 32% in RA and axSpA). For counseling/education, exercises to perform at home (70 and 78%) and physical activity (PA) promotion (48 and 49%) were most often reported in both RA and AxSpA. Conclusion Long-term use of PT is common in patients with RA and AxSpA. Apart from active treatment modalities (exercises) and promoting recommended PA, passive treatment options appear to be relatively often used. The results must be interpreted with caution, as the respondents may not constitute a representative sample of the IA population, yet warrant further research. Acknowledgements: This work was supported by the Dutch Arthritis Society [ReumaNederland], the Royal Dutch Society for Physical Therapy [KNGF] and The Netherlands Organisation for Health Research and Development [ZonMw]. Disclosure of Interests None declared